scholarly journals HM4 THE IMPACT OF A PHARMACIST-PROVIDED TELEPHONE MEDICATION THERAPY MANAGEMENT PROGRAM ON MEDICATION AND HEALTH-RELATED PROBLEMS, MEDICATION ADHERENCE, AND TOTAL DRUG COSTS AMONG MEDICARE BENEFICIARIES: A 6-MONTH FOLLOW-UP

2009 ◽  
Vol 12 (3) ◽  
pp. A15
Author(s):  
LR Moczygemba ◽  
JC Barner ◽  
KA Lawson ◽  
CM Brown ◽  
E Gabrillo ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Management Program ◽  
Medication Therapy Management ◽  
Drug Costs ◽  
Medicare Beneficiaries ◽  
Total Drug ◽  
Medication Therapy ◽  
Health Related ◽  
The Impact

Assessment of the Impact of Medication Therapy Management Delivered to Home-Based Medicare Beneficiaries

2009 ◽  
Vol 43 (4) ◽  
pp. 603-610 ◽  
Author(s):  
Erin K Welch ◽  
Thomas Delate ◽  
Elizabeth A Chester ◽  
Troy Stubbings
Keyword(s):  
Chronically Ill ◽  
Medication Therapy Management ◽  
Baseline Risk ◽  
Controlled Study ◽  
Medication Cost ◽  
Medicare Beneficiaries ◽  
Therapy Management ◽  
Medication Therapy ◽  
Medication Costs ◽  
The Impact

Background: Medication Therapy Management (MTM) is a voluntary patient participation program mandated for Medicare Part D sponsors by the Centers for Medicare and Medicaid Services for chronically ill beneficiaries with high medication costs/utilization. Objective: To assess the impact of an MTM program on mortality, healthcare utilization, and prescription medication costs and to quantify drug-related problems (DRPs) identified during MTM. Methods: This nonrandomized controlled study was conducted among beneficiaries who were targeted for MTM in 2006. The MTM intervention was designed to identify potential DRPs, educate the patient/caregiver about appropriate medication use, and ensure that the patient was appropriately integrated into clinical services. Data were collected from administrative databases and manual chart abstractions. Study outcomes included all-cause death (primary outcome), hospitalization, and emergency department (ED) visit rates and medication cost changes in the 180 days following MTM targeting and quantification of DRPs. Multivariate logistic regression was used to adjust the outcomes for baseline risk and other potential confounders. A mock MTM intervention was performed for beneficiaries who declined MTM and died, were hospitalized, and/or made an ED visit. Results: A total of 459 opt-in and 336 opt-out beneficiaries who agreed and declined, respectively, to receive MTM were included in the analysis. Beneficiaries who opted in were less likely to die compared with beneficiaries who opted out (adjusted OR [AOR] 0.5; 95% CI 0.3 to 0.9) but were more likely to have had a hospitalization (AOR 1.4; 95% CI 1.1 to 2.0) and an increase in medication costs (AOR 1.4; 95% CI 1.1 to 1.9) during follow-up. There was no difference in ED visit rates. At least one DRP was identified in more than 83% of beneficiaries in both groups, with the most common DRP being drug–drug interaction. Conclusions: Our investigation supports the use of MTM, with its increased coordination of information between healthcare providers and patients, since it may impact mortality positively in a population of high-risk Medicare beneficiaries.

scholarly journals Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP) on Medication Non-Adherence: Medication Adherence and Clinical Outcomes

2018 ◽  
Vol 9 (1) ◽  
pp. 11 ◽  
Author(s):  
Sharrel Pinto ◽  
Angela Simon ◽  
Feyikemi Osundina ◽  
Matthew Jordan ◽  
Diana Ching
Keyword(s):  
Body Mass Index ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Medication Therapy Management ◽  
Pill Count ◽  
Medication Therapy ◽  
Pill Bottle ◽  
Integrated Delivery ◽  
The Impact

Objective: To compare the impact of various pharmacy-based services on medication adherence and clinical outcomes. Design: Prospective, randomized control trial Setting: A local endocrinology group (clinic setting) and community pharmacies belonging to a regional integrated delivery network (IDN) in Toledo, OH Population: Subjects included within this study had type 2 diabetes, were prescribed a minimum of five medications, at least 18 years of age, having the ability to self-administer medications as prescribed, and be able to speak and understand English. Subjects were required to have Paramount health insurance, must be willing and able to provide informed consent, actively participate in the assigned MTM sessions, and have adequate transportation to attend the sessions at a participating pharmacy.  Methods: Patients were recruited through flyers at practice sites, referrals from physicians and pharmacists, and direct mailers. Members of the research team would screen patients to assess their eligibility to participate in the study. Patients who fit the inclusion criteria were randomized into one of the following four different groups: Pill Bottle (PB), Blister Pack (BP), Pill Bottle + Medication Therapy Management (PB+MTM), and Adherence Pharmacy (BP+MTM). Patients enrolled in the BP groups had their medications synchronized. Patients in the AP group were given the option to have their medications delivered, if needed. Practice innovation: We partnered with a regional integrated delivery network (IDN) with multiple community pharmacy practice sites and a practice group of endocrinologists. A new practice model called Adherence Pharmacy was conceptualized and implemented within the community setting and was accessible to patients. Main Outcomes Measures: Medication adherence, measured using proportions of days covered (PDC) and pill count scores at baseline, 3 months, 6 months, 9 months, and 12 months; Hemoglobin A1c (HbA1c), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressures (DBP) were collected at baseline, 6 months, and 12 months Results: A mixed-model ANOVA was used to study the impact of these services on medication adherence, using PDC and pill count scores. Results of the 61 patients in the study revealed that there was a statistically significant difference between the PB and BP groups (p=0.008); between the PB and BP+MTM groups (p=0.023); and between the PB+MTM and the BP+MTM groups (p=0.041). Except at baseline, adherence scores at all time points (0, 3, 6, 9, and 12 months) were significant with the patients in the BP and BP+MTM groups having higher adherence compared to those in the PB and PB+MTM groups. Pill count scores had similar results to the PDC measures. Insert data from HBA1c, BMI, SBP and DBP. Clinical outcomes were also analyzed using the mixed between-within ANOVA and were measured at baseline, 6, and 12 months. Patients in the MTM groups reached the American Diabetes Association goal of 7%, whereas the patients in the PB group did not reach a goal at 12 months. All groups, except for the PB only group, indicated a statistically significant change from baseline to 12 months. When comparing body mass index (BMI) scores across groups over time, patients in the BP+MTM group showed the lowest BMI at 12 months. There were not any significant differences across the groups, but patients in the two MTM groups saw greater improvement in their BMI scores than patients in the other two groups. There were no significant differences between groups in SBP and DBP reduction. However, patients in the two BP groups reached a SBP goal sooner (per the Eighth Joint National Committee) than patients in the PB+MTM and PB groups. Conclusion: Patients had improved clinical outcomes and adherence rates when using blister packaging and medication therapy management services, individually and in combination. Blister packaging seemed to have a greater impact on medication adherence while MTM services helped improve clinical endpoints. However, patients who received the combination of services offered within the AP demonstrated higher improved clinical outcomes and adherence rates when compared to patients who did not. While each of these services was found to be more impactful that dispensing medications in pill bottles, combining them can provide a greater benefit to patients.   Type: Original Research

Evaluation of a Hybrid Training Module for Community Pharmacy Staff Providing Hypertension Medication Therapy Management

2017 ◽  
Vol 31 (2) ◽  
pp. 183-189 ◽  
Author(s):  
Wendy I. Brown ◽  
Dan Cernusca ◽  
Leneika Roehrich
Keyword(s):  
Community Pharmacy ◽  
Management Program ◽  
Medication Therapy Management ◽  
Theoretical Frameworks ◽  
Pharmacy Staff ◽  
Web Based ◽  
Therapy Management ◽  
Instructional Process ◽  
Medication Therapy ◽  
The Impact

Purpose: The purpose of this research study was to evaluate the impact of web-based training on the knowledge and perceived practice of community pharmacy staff engaged in a hypertension medication therapy management program. Following the recommendations from adult learning end experiential learning theoretical frameworks, the proposed training engaged learners in a series of short online educational videos with preknowledge and postknowledge assessment and patient interactions in a clinical setting to reenforce newly learned skills. Methods: The participants in this study were from Community pharmacies who actively participate in medication therapy management and disease management services in the 2 largest towns in North Dakota. The preknowledge and postknowledge tests indicated a statistically significant improvement in hypertension management knowledge for the participating pharmacy staff. The qualitative input from the participants fully complemented these findings by showing a strong positive perception on the implemented instructional process. Results: Training proved to be both effective and essential for pharmacy staff when initiating clinical services to ensure they have the necessary skills to be able to do their job well, and online training is an easy and efficient way to provide this training.

scholarly journals How Risky Is That Risk Sharing Agreement? Mean-Variance Tradeoffs and Unintended Consequences of Six Common Risk Sharing Agreements

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832199040
Author(s):  
Gregory S. Zaric
Keyword(s):  
Risk Sharing ◽  
Financial Risk ◽  
Unintended Consequences ◽  
Drug Costs ◽  
New Drugs ◽  
Total Drug ◽  
Number Of Patients ◽  
Clinical Benefits ◽  
The Impact ◽  
Mean Variance

Background. Pharmaceutical risk sharing agreements (RSAs) are commonly used to manage uncertainties in costs and/or clinical benefits when new drugs are added to a formulary. However, existing mathematical models of RSAs ignore the impact of RSAs on clinical and financial risk. Methods. We develop a model in which the number of patients, total drug consumption per patient, and incremental health benefits per patient are uncertain at the time of the introduction of a new drug. We use the model to evaluate the impact of six common RSAs on total drug costs and total net monetary benefit (NMB). Results. We show that, relative to not having an RSA in place, each RSA reduces expected total drug costs and increases expected total NMB. Each RSA also improves two measures of risk by reducing the probability that total drug costs exceed any threshold and reducing the probability of obtaining negative NMB. However, the effects on variance in both NMB and total drug costs are mixed. In some cases, relative to not having an RSA in place, implementing an RSA can increase variability in total drug costs or total NMB. We also show that, for some RSAs, when their parameters are adjusted so that they have the same impact on expected total drug cost, they can be rank-ordered in terms of their impact on variance in drug costs. Conclusions. Although all RSAs reduce expected total drug costs and increase expected total NMB, some RSAs may actually have the undesirable effect of increasing risk. Payers and formulary managers should be aware of these mean-variance tradeoffs and the potentially unintended results of RSAs when designing and negotiating RSAs.

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